Central Purchasing: New Vendor Application

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New Vendor Application

Company Information:

Legal Company Name:*

DBA (if applicable)

Year In Business*

Federal Tax ID Number*

Duns & Bradstreet Number

Cage Code

Address*

City*

State*

Zip Code*

Contact Information

Sales & Service

Name*

Email Address*

Title*

Phone Number*

Fax Number

Authorized to Agent to Sign Bid and Quotes

Name*

Official Capacity*

Name

Official Capacity

Company Insight

Products and/or Services Offered*

Please check applicable categories.

Lawn Maintenance

Junk and Debris Removal

Board Ups

Demolition

Concrete Provider

Asphalt Provider

Construction

Water Project Provider

Sewer Project Provider

Motor Vehicle Pool Services

Police Equipment

Fire Equipment

Information Technology

General Supplies

Other

Other

Other

Payments

Do you agree to the City of Taylor net 30 payment schedule.*

Payment Types Accepted

City Issued Check*

Visa Credit Card*

Electronic Funds Transfer*

Automatic Clearing House*

Does the company hold one of the following registrations/certifications?

Please check those which apply.

SBA Certified Small Disadvantaged Business (DBE)

Section 3 Business Certifications

Minority Owned Business (MBE)

Veteran Owned Business (VSOB)

Service Disabled Veteran Owned (SDVOSB)

Women Owned Business (WBE)

Women Owned Small Business (WOSB)

Economically Disadvantaged Women Owned Small Business (EDWOSB)

Third-party certification for categories above.

Does any employee of the City of Taylor have financial interest, solely of partially in this company?*

If the answer to the previous question is "yes'", state the nature of interest held.

Copy of company's W-9*

Company's Certificate of Insurance

Contractor or Business License

Electronic Signature Agreement

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

I agree.

Electronic Signature

I certify that the information supplied herein (including all pages attached) is correct and that neither the applicant nor any person (or concern) in any connection with the applicant as a principal or officer, so far as is known, is now barred or otherwise declared ineligible by any public agency from bidding for furnishing, materials supplies, construction, or services to any agency thereof.